Does facility-based newborn care improve neonatal outcomes? A review of evidence

Context  

Facility based newborn care is gaining importance as an intervention aiming at reduction of neonatal mortality.     

Clinico-epidemiological profile of chronic suppurative otitis media patients attending a tertiary care hospital

The cross-sectional study was conducted to assess the clinico-epidemiological profile, perceptions and clinical profile of the chronic suppurative otitis media (CSOM) patients in a tertiary care hospital. A pretested questionnaire was used containing open questions and the patients were assessed clinically. Most patients (31.2%) were from 0-10 years age group and were males (58.8%). Majority of them (96%) lived in "kuccha" houses/slums, 76.8% practised unhygienic ear pricking, 36.8% poured oil in their ears, 70.8% bathed in ponds/rivers, 52.8% had ear discharge for more than 1 year. Among the respondents, 17.2% knew that CSOM was contagious, 24% thought CSOM ran in family, 20% knew CSOM is preventable. There was low threat perception and long time to seek care. Patients mostly presented with earache, deafness and discharge, most had deafness and safe variety of CSOM. More than half had comorbidities. Most of the previous study findings corroborated with the present study. Here was a substantial delay between the onset and treatment seeking due to lack of awareness and low threat perception. Pain and complications were the triggers for care-seeking. Education about the disease, strengthening the frontline workers and good referral system are suggested.     

Improved tandem mass spectrometry (MS/MS) derivatized method for the detection of tyrosinemia type I, amino acids and acylcarnitine disorders using a single extraction process

BackgroundSuccinylacetone (SUAC), a specific marker for tyrosinemia type I (Tyr I) cannot be detected by the routine LC-MS/MS screening of amino acids (AA) and acylcarnitines (AC) in newborns. The current derivatized methods require double extraction of newborn dried blood spots (DBS); one for AA and AC and the second for SUAC from the blood spot left after the first extraction. We have developed a method in which AA, AC and SUAC are extracted in a single extraction resulting in significant reduction in labor and assay time.MethodsThe 3.2 mm DBS were extracted by incubating at 45 °C for 45 min with 100 μl of acetonitrile (ACN)-water-formic acid mixture containing hydrazine and stable-isotope labeled internal standards of AA, AC and SUAC. The extract was derivatized with n-butanolic-HCl and analyzed by LC-MS/MS.ResultsThe average inter-assay CVs for, AA, AC and SUAC were 10.1, 10.8 and 7.1% respectively. The extraction of analytes with ACN-water mixture showed no significant difference in their recovery compared to commonly used solvent MeOH. The concentration of hydrazine had considerable impact on SUAC extraction.ConclusionWe developed a new MS/MS derivatized method to detect AA/AC/ SUAC in a single extraction process for screening Tyr I along with disorders of AA and AC.     

Rare magnetic resonance imaging findings in medium-chain acyl-coenzyme A dehydrogenase deficiency

A 3-year-old boy receiving valproate for 1.5 months presented with sudden-onset unprovoked seizures and unconsciousness. Hypoketotic hypoglycemia, hyperammonemia, and deranged liver function were detected. Elevated medium-chain urinary acylglycines and plasma acylcarnitine were detected. His serum valproate level was elevated. Valproate toxicity had been precipitated in presence of medium-chain acyl-CoA dehydrogenase deficiency. Cranial magnetic resonance imaging brain indicated unilateral basal ganglia ischemia instead of the bilateral changes expected in metabolic disease.